Distinguishing Pain versus Psychiatric Behavior in Alzheimer's Disease Patients

Abstract

Alzheimer's Disease (AD) patients are at risk for not having their pain recognized. When nurses do not have adequate knowledge and tools to help determine if an AD patient is experiencing pain this often results in ignored and under-treated pain (Malara et al., 2016). In nursing staff working in a long-term care (LTC) facility (P) how does a multifaceted educational approach utilizing Registered Nurses' Association of Ontario (RNAO) and Management of Pain Clinical Best Guidelines (I) increase the competence level in distinguishing pain versus psychiatric behaviors in AD patients (O) over a period of 90 days? The local problem involves nurses working in a long-term care facility that are experiencing difficulties recognizing pain in patients with AD. Data collected from PAINAD assessments was analyzed using a paired t-test. Application of PAINAD assessment tool, following RNAO's Assessment and Management of Pain Clinical Best Practice Guidelines and guided by the use of the Plan-Do-Study-Act (PDSA) framework. Nurses were given a pre-and-post survey, were provided education on using the PAINAD assessment tool, and received support through random audits, chart reviews, and continued education as they utilized the assessment tool on their unit. There was a significant difference in the scores of the facilities original pain scale (M = 0.3786, SD = 1.24551) compared to the alternative PAINAD assessment tool (M = 0.6893, SD = 1.48221) conditions; t (4) = -2.814, p =0.006. In conclusion, implementation of the PAINAD assessment tool resulted in a statistical significance in the nurse's ability to detect pain in AD patients during this pilot project. This trend of improvement occurred despite the small sample size and short project timeframe.